Guest Writer: Kayleigh Saafield
What are “Exclusion Checks”? Do we need to complete them?
As a health care provider, it’s your responsibility to monitor who you employ and who you hold contracts with. This key area of compliance and risk mitigation is not only a requirement, but it ensures continuity of care and regulatory compliance. It is important to be proactive with these checks as the US Department of Health and Human Services Office of Inspector General has the authority to impose civil financial penalties on health care providers who employ or contract with excluded entities.
Where are these checks completed?
Checks are completed using three databases; OIG (List of Excluded Individuals/Entities of the Office of Inspector General), SAM (System for Award Management) and State Exclusion Lists.
Who needs to be checked?
Exclusion checks should be completed for employees, contractors, vendors and volunteers.
When should they be checked?
Checks should be completed prior to hire of all new staff members. For contracted providers and vendors, checks should be completed prior to the signing of the contract. It’s best practice that contracts include a clause stating that if the provider ends up on a state or federal exclusion list, the contract will terminate at that time. Exclusion checks should be completed on a monthly basis.
How do we use the OIG, SAM and state databases?
Look for individuals by name and verify their social security number (SSN). For entities, verify the identity using their Employer Identification Number (EIN). For state checks, verify the type of sanction. Some individuals/entities may just have received a monetary penalty. Do not hire or contract with individuals who have final judgement of exclusion.
Helpful tips when using the databases:
For individuals, check their legal names and any disclosed aliases, e.g. maiden names. An individual with a hyphenated name should be checked under each of the last names in the hyphenated name. For entities, check their legal and fictitious names. For small organizations, it may also be useful to check the owner’s name. e.g. if you contract with Dr. Smith’s Medical Offices, Inc, and the sole owner and provider is Dr. Bob Smith, check the entity “Dr. Smith’s Medical Offices” and the individual “Bob Smith”.
What are state exclusion checks?
In addition to the federal exclusion lists, vendors and employees should be checked against state exclusions lists- which pertains specifically to state reimbursement. Just as with the federal databases, it is best practice to verify and document all names and companies against the state exclusion checks on a monthly basis, and prior to any employment/contractual agreement.
Where are the databases?
Links are listed below:
If a vendor or employee comes up with a result in the search, contact your regional teams or legal consultant for more information on how to proceed.